Organization
ILLUMINATE LIFE THERAPY, LLC
Active
Organization
ILLUMINATE LIFE THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN HOLLISTER LISW (OWNER)
(515) 520-8164
Entity
Organization
Contact information
Practice address
1605 N ANKENY BLVD STE 110, ANKENY, IA 50023-4163
(515) 520-8164
Mailing address
1605 N ANKENY BLVD STE 110, ANKENY, IA 50023-4163
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/11/2023
Last updated
08/16/2023
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